Changes in life expectancy and disease burden in Norway, 1990-2019: an analysis of the Global Burden of Disease Study 2019.

BACKGROUND: Geographical differences in health outcomes are reported in many countries. Norway has led an active policy aiming for regional balance since the 1970s. Using data from the Global Burden of Disease Study (GBD) 2019, we examined regional differences in development and current state of health across Norwegian counties. METHODS: Data for life expectancy, healthy life expectancy (HALE), years of life lost (YLLs), years lived with disability (YLDs), and disability-adjusted life-years (DALYs) in Norway and its 11 counties from 1990 to 2019 were extracted from GBD 2019. County-specific contributors to changes in life expectancy were compared. Inequality in disease burden was examined by use of the Gini coefficient. FINDINGS: Life expectancy and HALE improved in all Norwegian counties from 1990 to 2019. Improvements in life expectancy and HALE were greatest in the two counties with the lowest values in 1990: Oslo, in which life expectancy and HALE increased from 71·9 years (95% uncertainty interval 71·4-72·4) and 63·0 years (60·5-65·4) in 1990 to 81·3 years (80·0-82·7) and 70·6 years (67·4-73·6) in 2019, respectively; and Troms og Finnmark, in which life expectancy and HALE increased from 71·9 years (71·5-72·4) and 63·5 years (60·9-65·6) in 1990 to 80·3 years (79·4-81·2) and 70·0 years (66·8-72·2) in 2019, respectively. Increased life expectancy was mainly due to reductions in cardiovascular disease, neoplasms, and respiratory infections. No significant differences between the national YLD or DALY rates and the corresponding age-standardised rates were reported in any of the counties in 2019; however, Troms og Finnmark had a higher age-standardised YLL rate than the national rate (8394 per 100 000 [95% UI 7801-8944] vs 7536 per 100 000 [7391-7691]). Low inequality between counties was shown for life expectancy, HALE, all level-1 causes of DALYs, and exposure to level-1 risk factors. INTERPRETATION: Over the past 30 years, Norway has reduced inequality in disease burden between counties. However, inequalities still exist at a within-county level and along other sociodemographic gradients. Because of insufficient Norwegian primary data, there remains substantial uncertainty associated with regional estimates for non-fatal disease burden and exposure to risk factors. FUNDING: Bill & Melinda Gates Foundation, Research Council of Norway, and Norwegian Institute of Public Health.

Socioeconomic inequalities in children's weight, height and BMI trajectories in Norway.

Studies exploring when social inequalities in body mass index (BMI) and its composites emerge and how these evolve with age are limited. Thus, this study explored parental income and education related inequalities in children's weight, height, weight velocity and body mass index among Norwegian children from 1 month to 8 years. The study population included 59,927 family/children pairs participating in the Norwegian Mother, Father, and Child Cohort Study. Growth was modelled using the Jenss-Bayley model and linear mixed effects analyses were conducted. Maternal and paternal educational differences in children's weight and BMI trajectories emerged during infancy, continuing to age 8 years. Parental income-related inequalities in children's weight were observed from the age of 1 month to 4 years for maternal and up to 1 year for paternal income-related differences but then disappeared. Parental income-related inequalities in child's BMI were observed from 18 months to 8 years for maternal income, and from 9 months to 8 years for paternal income-related differences. These results suggest that social inequalities in children's BMI present early in infancy and continue to 8 years of age. The inequalities sometimes differed by indicator of socioeconomic position used. Interventions to combat these inequalities early in life are, thus needed.

Mediators of socioeconomic inequalities in dietary behaviours among youth: A systematic review.

Children and adolescents with a lower socioeconomic position have poorer dietary behaviours compared to their counterparts with a higher socioeconomic position. A better understanding of the mechanisms behind such socioeconomic inequalities is vital to identify targets for interventions aimed at tackling these inequalities. This systematic review aimed to summarize existing evidence regarding the mediators of socioeconomic differences in dietary behaviours among youth. A systematic literature search of MEDLINE, Embase, PsycINFO, and Web of Science databases yielded 20 eligible studies. The dietary behaviours included in the reviewed studies were the intake of fruit and vegetables, sugar-sweetened beverages, unhealthy snacks/fast food and breakfast. The consistent mediators of the effects of socioeconomic position on dietary behaviours among youth were: self-efficacy, food preferences and knowledge at the intrapersonal level; and availability and accessibility of food items at home, food rules and parental modelling at the interpersonal level. Few studies including mediators at the organisational, community or policy levels were found. Our review found several modifiable factors at the intrapersonal and interpersonal levels that could be targeted in interventions aimed at combating inequalities in dietary behaviours among youth. Rigorous studies exploring organisational, community and policy level mediators are warranted.

Assessment of women's satisfaction with family planning service at public health facilities in Northwest Region of Ethiopia: a cross sectional study.

BACKGROUND: Ethiopia is a Sub Saharan African country with an estimated contraceptive prevalence rate of 36% and 22% unmet need for family planning service among married women. Client satisfaction influences the use of Family Planning and other reproductive health services. There is limited information on satisfaction with family planning service among Family planning users particularly in the northern part of Ethiopia. Hence, this study aimed to provide information on client satisfaction and its determinant among women in Public Health facilities of Northwestern Ethiopia. METHODS: A Facility based cross-sectional study was conducted from March 1, 2017, to March 30, 2017. An exit interview using structured pretested questionnaire was conducted on randomly selected 490 women attending family planning service in Bahir Dar city, Public Health facilities of Northwest, Ethiopia. The data was cleaned, coded and entered into Epi info™ 7 statistical software and then exported and analyzed using SPSS Version 20 statistical software. A multivariable binary logistic regression model was fitted to identify factors associated with Client satisfaction. Adjusted Odds Ratio (AOR) with the corresponding 95% Confidence Interval (CI) was calculated to show the strength of association. RESULTS: A total of 490 family planning service users were approached for an interview and making a response rate of 99.8%. The overall client satisfaction with the family planning services was found to be 66.1%. Clients who were merchants were more likely to be satisfied with the family planning service than government employees [AOR = 2.5, P-value = 0.007). In addition, house wife's more likely to be satisfied with the family planning service than government employees AOR = 2.4, P-value = 0.007). Daily laborers were also found to be more likely to be satisfied with the FP service as compared with governmental employees AOR = 3.9, P-value = 0.007). New Family Planning user clients were more likely to be satisfied with the family planning service than repeat users [AOR = 2.3, P-value = 0.004).Family planning service waiting time also affects client satisfaction, in which those having awaiting time of less than half an hour's (AOR = 9.7, (P-value =001), One to half an hour (AOR = 6.4, (P-value =001), One hour to two hours (AOR = 4.6, (P-value =001) were more likely to be satisfied with the family planning service delivered at the facility than those who had waited for more than two hours. In addition, those whose privacy was maintained during counseling were more likely to be satisfied with the family planning service delivered than whose privacy was not maintained (AOR = 3.2, P-Value = < 0.001). Those having convenient service hour were more likely to be satisfied with the family planning service delivered than those who don't have convenient service hour (AOR = 2.4, p-value = 0.002). CONCLUSION: The finding of this study concludes that nearly two -third of the clients were satisfied with the family planning service delivered at Public Health facilities of Northwest of Ethiopia. New family planning service users, waiting time for the service, Maintaining privacy during counseling, having convenient service hour and occupational status of the clients were the predictors for client satisfaction with family planning service delivered at Public Health facilities in Bahir Dar city.